Jan Frich

• Granberg, Anette L.; Walsem, Marleen Regina Van; Ørstavik, Kristin; Andries, Aristomo Ibnu Chalid & Frich, Jan C (2026). Exploring the experiences of physical activity in people with Charcot-Marie-Tooth disease: a qualitative study. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2026.2665677. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Physical activity may improve the function and well-being of individuals with Charcot-Marie-Tooth disease (CMT). We conducted a study to explore patients’ experiences related to physical activity, investigating how physiotherapists may promote and facilitate activity. Materials and methods A qualitative study eliciting 10 patients’ and 12 physiotherapists’ views in four focus groups. Results Previous experiences shaped how individuals with CMT viewed physical activity. Both individuals with CMT and physiotherapists emphasised a tailored approach that acknowledged personal perspectives, as feeling understood increased motivation. Physiotherapists could facilitate activity and mastery by validating patients’ bodily experiences, reassuring them that occasional pain and fatigue are normal, raising awareness of how daily cumulative demands affect symptoms, and assessing signs of abnormal responses. Individuals with CMT recognised that inactivity led to stiffness and heaviness, motivating them to stay active. Both groups called for improved knowledge, collaboration, access to skilled physiotherapists, and stronger professional networks. Conclusion Previous experiences and beliefs about the benefits and harms of physical activity influence individuals with CMT regarding their views on physical activity. Physiotherapists may promote engagement by nurturing therapeutic relationships and personalising their approach. The shortage of qualified professionals and facilities may restrict opportunities for those with CMT.

• Eriksen, Astrid; Rechel, Bernd; Dodsworth, Emma; Reed, Sarah; Adamsson, Elisabeth & Anell, Anders [Vis alle 22 forfattere av denne artikkelen] (2026). Policies and initiatives to facilitate timely discharge from hospitals: a comparison of six European countries. Health Policy. ISSN 0168-8510. 168. doi: 10.1016/j.healthpol.2026.105595. Fulltekst i vitenarkiv Vis sammendrag

  Background Timely discharge of patients who are clinically ready to be discharged from hospitals to the next point of care is a common health system challenge. Ensuring safe and effective discharge holds new urgency, given the backlogs and increased waiting times for inpatient services in many countries after the COVID-19 pandemic. Objective The study aimed to identify policy options for addressing delayed discharges in six European countries (Denmark, France, Germany, the Netherlands, Norway, and Sweden), and to summarise available evidence on their effectiveness. Methods Experts from the Health Systems and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies and additional country experts identified relevant policies and initiatives up to November 2023. When evaluations were available, the experts also provided information on their findings. The data collection was followed by a qualitative, cross-country comparative analysis. Results A total of 17 policies or initiatives were identified in the study countries. Hospital-based initiatives included discharge planning and transitional care. Community and home care initiatives included municipal emergency beds, intensive home rehabilitation, and assisted discharge. Cross-sectoral initiatives ranged from coordination efforts at the regional and municipal levels to decision support systems and financial incentives. Conclusion Several common factors or principles underpin many of the identified policies and initiatives. These include clarity of responsibility, effective planning and communication, resourcing of community-based capacity, possible unintended consequences of financial penalties, and the need to adopt a systemic approach.

• Fossberg, Bettina Caroline; Frich, Jan C & Spehar, Ivan (2025). Norwegian district medical officers’ experiences during Covid-19: a qualitative study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948251394900. Fulltekst i vitenarkiv Vis sammendrag

  Background/aims: Municipalities in Norway are required to have a district medical officer (DMO) as chief medical advisor and leader of infection control and prevention work. There is great variation between municipalities in how the role is enacted and organized. Before the Covid-19 pandemic many DMOs felt their role to be unclear and invisible in the organization. This study aimed to explore DMOs’ experiences during the Covid-19 pandemic and how organizational context mediated these experiences. Methods: We conducted a qualitative study, generating data from three focus groups involving 17 DMOs from three different regions in Norway. Data were analysed using systematic text condensation. Results: All DMOs, regardless of municipal size, position size or infection rate, reported feeling overwhelmed by the responsibility during the pandemic. Their organizational outset, number of tasks, number of enquiries and uncertain foundation for decisions contributed to this experience. Organizational characteristics that promoted DMOs’ coping were resource allocation, teamwork, and professional and social support. Conclusions: Our results suggest that municipalities can enhance their crisis management of future infection control crises by establishing an organizational structure around DMOs that facilitates networking, and by developing plans for task delegation and creation of teams to support and alleviate DMOs during a crisis.

• Frich, Jan C (2025). Building capacity for clinical leadership. Michael. ISSN 1893-9651. 22(34), s. 36–41. doi: 10.56175/michael.12581. Fulltekst i vitenarkiv Vis sammendrag

  High-quality healthcare increasingly relies on teams, collaboration, and interdisciplinary work, and clinical leadership is essential for optimizing and improving health system performance. Healthcare systems that are serious about transformation and innovation must harness the energies of their clinicians as leaders. How can we achieve this? How can health systems build capacity for clinical leadership through leadership development?

• Fossmo, Hanne Ludt; Ellefsen-Martinsen, Mari; Ørstavik, Kristin; Arora, Tarun; Frich, Jan C & Robinson, Hilde Stendal (2025). Psychometric properties of MFM32 in Myotonic Dystrophy type 1. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. doi: 10.1016/j.apmr.2025.10.013. Fulltekst i vitenarkiv Vis sammendrag

  Objective To examine the psychometric properties of the Motor Function Measure 32 (MFM32) in adults with myotonic dystrophy type 1 (DM1). MFM32 is an instrument for evaluating function in neuromuscular diseases that have not been adequately assessed in DM1. Design Cross-sectional study using video recording of the performance for evaluation of intra- and inter-rater reliability. Setting Data collection was performed at 5 different sites (3 neurologic departments, 1 rehabilitation center, 1 center for rare disorders) and in several of the participants’ home. Participants Convenience sample of 86 adults (N=86) with DM1. Interventions Not applicable. Main Outcome Measures The MFM32. The objective was to assess internal consistency, intra and inter-rater reliability, measurement error, convergent validity, and floor and ceiling effects of MFM32 in adults with DM1. We analyzed the total percentage score and the 3 domain scores: D1 (standing and transfers), D2 (axial, proximal motor function), and D3 (distal motor function). Results Internal consistency measured by Cronbach’s alpha for the total percentage score was 0.94. For the 3 domains it was 0.95 (D1), 0.70 (D2), and 0.66 (D3). The intra-rater reliability coefficients were excellent (ICC2.1=0.96-0.99), and the inter-rater reliability coefficients were good to excellent (ICC2.1=0.86-0.99). SEM of the total percentage score was 1.59 for the intra-rater reliability and 1.66 for the inter-rater reliability. Minimal detectable change was 4.42 for the intra-rater reliability and 4.6 for the inter-rater reliability. Convergent validity was medium to high. There was a tendency for a ceiling effect on the total percentage score, as well as on some of the domain percentage scores. Conclusions The MFM32 has a high internal consistency, intra- and inter- rater reliability, and convergent validity in adults with DM1. Calculated SEM and minimal detectable change were low. There is a ceiling effect of MFM32, especially in the distal function domain and among the participants with high motor function.

• Kinge, Jonas Minet; Øien, Henning; Dieleman, Joseph L.; Reme, Bjørn-Atle; Knudsen, Ann Kristin Skrindo & Godager, Geir [Vis alle 11 forfattere av denne artikkelen] (2025). Forecasting total and cause-specific health expenditures for 116 health conditions in Norway, 2022–2050. BMC Medicine. 23(1). doi: 10.1186/s12916-025-03917-2. Fulltekst i vitenarkiv Vis sammendrag

  Background This study forecasts total and cause-specific health expenditures in Norway to 2050 and quantifies the contribution of four key drivers—total population growth, population aging, changes in disease prevalence, and cost per case—on future health care spending. Methods We forecast spending for 116 health conditions in Norway from 2022 to 2050, using historical and forecasted data of population growth, disease prevalence, gross domestic product (GDP), health spending, and residual factors. Our analysis included a reference scenario that forecasted disease-specific health spending; two alternative scenarios examining the effects of alternative unit cost developments; and a scenario examining the consequences of improved behavioral and metabolic risk factors. Results Health spending increased from 10.6% (95% uncertainty interval, 10.2–11.1) of GDP in 2022 to 14.3% (13.0–15.7) in 2050 in the reference scenario. Among the top aggregate causes of Norwegian health spending in 2022, the spending for neurological disorders rose the most, from 1.7% (1.6–1.8) to 2.7% (2.3–3.1) of GDP, surpassing mental and substance use disorders which rose from 2.2% (2.1–2.3) to 2.4% (2.2–2.6) of GDP. Of the 116 single conditions analyzed, dementias accounted for the highest spending in 2022. This expenditure was forecasted to increase considerably from 1.1% (1.09–1.2) to 1.9% (1.6–2.2) of GDP by 2050, largely due to population aging. Spending on other old-age-related conditions like falls, stroke, and diabetes, was also forecasted to increase. Increased population, aging, and spending per case contributed to increased future spending. Reduced behavioral and metabolic risks were forecasted to increase the number of elderly persons and reduce age-specific disease prevalence but had little impact on forecasted health spending. Conclusions Health spending growth was forecasted regardless of the scenario, and Norway needs to plan for this. However, policymakers can curb total spending growth, while maintaining health care quality and output, by ensuring more efficient allocation and effective use of resources. While the overall impact of behavioral and metabolic risk reductions on total healthcare spending was modest, reducing risk factors is needed if countries aim to achieve a healthier, longer-living population.

• Fossmo, Hanne Ludt; Ørstavik, Kristin; Gurandsrud, Aagot; Frich, Jan C & Robinson, Hilde Stendal (2025). Rehabilitation technology in assessment and treatment of arm and hand function in Myotonic Dystrophy type 1: a single subject experimental design study. Journal of Neuromuscular Diseases. ISSN 2214-3599. 13(1), s. 1–12. doi: 10.1177/22143602241301675. Fulltekst i vitenarkiv Vis sammendrag

  Background: Myotonic Dystrophy type 1 (DM1) is a slowly progressive hereditary neuromuscular disorder affecting several organ systems including the musculoskeletal system. Objective: To examine the effects of rehabilitation technology on arm and hand function in the assessment and treatment of adults with DM1 with moderate to severe muscle impairment. Methods: A single subject experimental design study (SSED) with 6 participants. The assessments were done weekly through remote study assessments using the video-conference system Whereby®. Participants performed the nine-hole peg test (NHPT), active range of motion (AROM) of the shoulder and patient reported outcome measures (PROMS). Three participants also measured grip and pinch strength and performed the Nut and Bolt task. The intervention was a three-week in-patient rehabilitation stay with the use of rehabilitation technology for exercising arm and hand function. Exercises were performed in AMADEO and the ArmeoSenso. The participants exercised the upper extremities for 30 min 5 times a week. Results: Improvement on the NHPT test on the dominant hand were found for five of the six participants. Three of six improved on the non-dominant hand and in AROM. Two of the three participants that measured pinch and grip strength improved, and all three improved on the Nut and Bolt task. Self- reported function, myotonia and fatigue remained stable. All participants were able to participate in video assessments. Conclusions: Impairment in arm- and hand function affects independence in people with DM1.Our findings suggest that exercising arm- and hand using rehabilitation technology may have a positive effect on function measured by dexterity, strength, and movement in DM1. There is a need to study the effect of exercise on arm- and hand function in DM1 in larger studies. The use of video-consultations can be a supplement in assessment of people with neuromuscular conditions in research and clinical practise.

• Walsem, Marleen Regina Van; Howe, Emilie Isager; Andelic, Nada & Frich, Jan C (2024). Primary health care professionals’ experiences with caring for patients with advanced Huntington’s disease: a qualitative study. BMC Primary Care. 25(1). doi: 10.1186/s12875-024-02408-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Huntington’s disease (HD) has substantial impact on patients and carers’ lives. Managing patients in the advanced phase of HD may be challenging to primary health care professionals. The aim of this study is to elicit health care professionals’ experiences of managing the challenges with patients with advanced HD in primary health care. Methods We did a qualitative study, collecting data from four focus group interviews with 22 primary health care professionals who had experience with caring for patients with HD in Norway. The data were analysed using a qualitative content analysis method, systematic text condensation. Results We found that health care professionals who care for patients with HD in primary health care experience challenges related to patients’ behaviour, family members and caregivers, professionals’ individual competency, and the organizational context. They conveyed that successful care and management of patients with advanced HD was dependent on individuals’ competency and “everyday tactics”, well-functioning teams, and leadership and organizational support. Conclusion In addition to individual competencies, including being personally suitable for the job, well-functioning primary care teams, and organization support and training is important for health care professionals’ ability to manage patients with advanced HD in primary health care.

• Basterrechea, Sylvia; Frich, Jan C & Garman, Andrew N. (2024). Future-ready healthcare leadership: the revised International Hospital Federation Competency Model. BMJ Leader. 9(1), s. 80–82. doi: 10.1136/leader-2023-000925. Fulltekst i vitenarkiv Vis sammendrag

  Background Major global trends are reshaping health services delivery, and preparing current and future healthcare leaders requires an understanding of these trends. A well-designed leadership competency model can provide guidance for individuals, as well as for system-level leadership development and integration programmes. Objective To describe the process of updating the International Hospital Federation’s (IHF) Global Healthcare Management Competency Directory. Methods Revisions were informed by a recent foresight study of major trends in health services delivery, and an evidence-informed framework of leadership competencies. The original framework competencies were reviewed by 45 subject-matter experts from 30 countries and regions, who provided feedback through electronic surveys and online interviews. We incorporated this iterative feedback to revise the framework design, competencies within the framework and their associated behavioural descriptions. Results A total of 45 subject-matter experts from 30 countries and regions participated in 1 or more phases of the survey process. The resulting leadership competency model includes 32 competencies organised into a framework of 6 domains: values, self-development, execution, relations, context management and transformation. Conclusion The updated IHF Leadership Model provides a robust, evidence-based and up-to-date resource for assessing and developing future-ready healthcare leaders.

• Frich, Jan C (2024). Nytt kompetanserammeverk for helseledelse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(4), s. 1–3. doi: 10.4045/tidsskr.24.0082. Fulltekst i vitenarkiv
• Solbakken, Gro; Løseth, Sissel; Frich, Jan; Dietrichs, Espen & Ørstavik, Kristin (2024). Small and large fiber neuropathy in adults with myotonic dystrophy type 1. Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1375218. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disorder that affects multiple organs. In this study, we investigated symptoms of pain and presence of small and large fiber neuropathy in the juvenile and adult form of DM1.<p> <p>Method: Twenty genetically verified DM1 patients were included. Pain was assessed, and neurological examination and investigations of the peripheral nervous system by quantification of small nerve fibers in skin biopsy, quantitative sensory testing and nerve conduction studies were performed. Results from skin biopsies were compared to healthy controls. <p>Result: Seventeen patients reported chronic pain. Large and/or small fiber abnormalities were present in 50% of the patients. The intraepidermal nerve fiber density was significantly lower in the whole group of patients compared to healthy controls. <p>Conclusion: Small-fiber neuropathy might be an important cause of pain in DM1.

• Geerts, Jaason; Udod, Sonia; Bishop, Sharon; Hillier, Sean; Lyons, Oscar & Madore, Suzanne [Vis alle 9 forfattere av denne artikkelen] (2024). Gold standard research and evidence applied: The Inspire Nursing Leadership Program. Healthcare Management Forum (HMF). ISSN 0840-4704. 37(3), s. 141–150. doi: 10.1177/08404704241236908. Fulltekst i vitenarkiv Vis sammendrag

  Billions of dollars are invested annually in leadership development globally; however, few programs are evidence-based, risking adverse outcomes, and wasted time and money. This article describes the novel Inspire Nursing Leadership Program (INLP) and the outcomes-based process of incorporating gold standard evidence into its design, delivery, and evaluation. The INLP design was informed by a needs analysis, research evidence, and by nursing, Indigenous, and equity, diversity, and inclusion experts. The program’s goals include enabling participants to develop leadership capabilities, cultivate strategic community partnerships, lead innovation projects, and connect with colleagues. Design features include an outcomes-based approach, the LEADS framework, and alignment with the principles of adult learning. Components include leadership impact projects, 360-assessments, blended interactive sessions, coaching, mentoring, and application and reflection exercises. The evaluation framework and subsequent proposed research design align to top-quality standards. Healthcare leadership programs must be evidence-based to support leaders in improving and transforming health systems.

• Frich, Jan C (2024). Det tause språket. Michael. ISSN 1893-9651. 21, s. 116–118. doi: 10.5617/michael.11711. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Medisinske tema og myter i Jonas Fjeld-serien. Michael. ISSN 1893-9651. 21(Suppl. 33), s. 65–82. doi: 10.5617/michael.11706. Fulltekst i vitenarkiv Vis sammendrag

  Dr. Jonas Fjeld ble skapt av journalisten og forfatteren Øvre Richter Frich (1872–1945). I årene 1911–1935 ble det utgitt 21 bøker om «den blonde kjempe». Bøkene er blitt kritisert for å være rasistiske og diskriminerende, og samtidig har flere generasjoner lesere latt seg fascinere av fortellingene om den norske kirurgen. Da Den norske legeforening markerte sitt 100-årsjubileum i juni 1986, hadde foreningen en annonsekampanje i dagspressen der man spilte på et Jonas Fjeld-sitat: «Jeg er norsk læge, sa han enkelt, og mengden vek til side». Hvem var Øvre Richter Frich? Hva formidler bøkene i Jonas Fjeld-serien? Hvilke medisinske tema og myter inneholder bøkene? Artikkelen er basert på studier av arkivmateriale, nærlesning av førsteutgaver og nyere versjoner av bøkene om Jonas Fjeld samt studier av annen litteratur og bøker som omhandler Øvre Richter Frich og hans forfatterskap.

• Haavet, Ole Rikard; Myhrer, Kristin S.; Kates, Nick; Mdala, Ibrahimu; Aschim, Bente & Lundevall, Sverre [Vis alle 8 forfattere av denne artikkelen] (2023). Impact of a cognitive behavioural therapy training program on family physician practices: Cross-sectional study in Norway. Canadian Family Physician (CFP). ISSN 0008-350X. 69(11), s. 784–791. doi: 10.46747/cfp.6911784. Fulltekst i vitenarkiv
• Wiig, Siri; Macrae, Carl James; Frich, Jan C & Øyri, Sina Furnes (2023). Naming the “baby” or the “beast”? The importance of concepts and labels in healthcare safety investigation. Frontiers in Public Health. 11, s. 1–4. doi: 10.3389/fpubh.2023.1087268. Fulltekst i vitenarkiv Vis sammendrag

  This paper focuses on concepts and labels used in investigation of adverse events in healthcare. The aim is to prompt critical reflection of how different stakeholders frame investigative activity in healthcare and to discuss the implications of the labels we use. We particularly draw attention to issues of investigative content, legal aspects, as well as possible barriers and facilitators to willingly participate, share knowledge, and achieve systemic learning. Our message about investigation concepts and labels is that they matter and influence the quality of investigation, and how these activities may contribute to system learning and change. This message is important for the research community, policy makers, healthcare practitioners, patients, and user representatives.

• Tjomsland, Ole; Thoresen, Christian; Ingebrigtsen, Tor; Søreide, Eldar & Frich, Jan C (2023). Reducing unwarranted variation: can a ‘clinical dashboard’ be helpful for hospital executive boards and top-level leaders? BMJ Leader. 8, s. 186–190. doi: 10.1136/leader-2023-000749. Fulltekst i vitenarkiv Vis sammendrag

  Background/aim: In the past decades, there has been an increasing focus on defining, identifying and reducing unwarranted variation in clinical practice. There have been several attempts to monitor and reduce unwarranted variation, but the experience so far is that these initiatives have failed to reach their goals. In this article, we present the initial process of developing a safety, quality and utilisation rate dashboard (‘clinical dashboard’) based on a selection of data routinely reported to executive boards and top-level leaders in Norwegian specialist healthcare. Methods: We used a modified version of Wennberg’s categorisation of healthcare delivery to develop the dashboard, focusing on variation in (1) effective care and patient safety and (2) preference-sensitive and supply-sensitive care. Results: Effective care and patient safety are monitored with outcome measures such as 30-day mortality after hospital admission and 5-year cancer survival, whereas utilisation rates for procedures selected on cost and volume are used to follow variations in preference-sensitive and supply-sensitive care. Conclusion: We argue that selecting quality indicators of patient safety, quality and utilisation rates and presenting them in a dashboard may help executive hospital boards and top-level leaders to focus on unwarranted variation.

• Fossmo, Hanne Ludt; Ørstavik, Kristin; Frich, Jan C & Robinson, Hilde Stendal (2023). Translation, reliability, and validity of the Norwegian version of the ABILHAND-NMD and the ACTIVLIM for Myotonic Dystrophy type 1. Disability and Rehabilitation. ISSN 0963-8288. 46(12), s. 2699–2707. doi: 10.1080/09638288.2023.2231848. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To translate ABILHAND-NMD and ACTIVLIM into Norwegian and assess their psychometric properties in adults with Myotonic Dystrophy type 1(DM1). Methods ABILHAND-NMD and ACTIVLIM were translated into Norwegian through a standardized translation process. Psychometric properties of the translated questionnaires were tested. Intraclass correlation coefficient (ICC3.1) was used to assess test-retest reliability and Cronbach’s α for internal consistency. The validity of the questionnaires was also assessed. Results A total of 39 adults with DM1 were included. We found excellent test-retest reliability on ABILHAND-NMD (ICC 0.91) and ACTIVLIM (ICC 0.93). We found a good internal consistency of ABILHAND-NMD with Cronbach’s α (95%CI) of 0.80 (0.69–0.88) and ACTIVLIM with Cronbach’s α (95%CI) of 0.88 (0.82–0.93) An expert group of healthcare professionals and a pilot group reported good face and content validity. We found a high correlation between ABILHAND-NMD and ACTIVLIM (r = 0.75), p < 0.001 implying good convergent validity. ABILHAND-NMD and ACTIVLIM showed no floor effect, but a potential for ceiling effect. Conclusion The Norwegian versions of ABILHAND-NMD and ACTIVLIM are reliable and valid patient reported outcome measures for Myotonic Dystrophy type 1. The questionnaires are easy to administer as they take a short time to answer, and the participants reported no problems understanding the questions. Implications for rehabilitation Myotonic Dystrophy type 1 cause myopathy and altered muscle function. Impaired arm- and hand function increases patients’ need for assistance and reduces independence. The use of patient reported outcome measures (PROMs) to uncover impairments and activity limitations is important in clinical practice and research. The Norwegian versions of ABILHAND-NMD and ACTIVLIM are reliable and valid measures of manual ability and activity limitations for adults with Myotonic Dystrophy type 1.

• Andries, Aristomo; Walsem, Marleen Regina Van; Ørstavik, Kristin & Frich, Jan C (2022). Functional Ability and Physical Activity in Hereditary Neuromuscular Diseases. Journal of Neuromuscular Diseases. ISSN 2214-3599. 9(3), s. 437–446. doi: 10.3233/JND-210677. Fulltekst i vitenarkiv Vis sammendrag

  Background: Physical activity may help to promote health in patients with Limb-girdle muscular dystrophy (LGMD) and Charcot-Marie-Tooth disease (CMT). Objective: To investigate associations between functional ability and other variables, with physical activity in people with LGMD and CMT grouped according to the International Classification of Functioning, Disability, and Health (ICF). Methods: We did a cross-sectional study, recruiting respondents from the Norwegian registry of inherited neuromuscular disorders. We used the Norwegian version of Barthel index of Activities of Daily Living (ADL) to measure functional ability and the International Physical Activity Questionnaire –short form (IPAQ-sf) to classify physical activity. We used multivariable logistic regression analysis to investigate associations between variables. Results: 145 subjects were recruited (79 with CMT and 66 with LGMD). 55.6% of the subjects met a minimum recommendation of physical activity. Participants with moderate to severe functional ability were more likely to be physically inactive compared to those with normal functional ability (OR 19.7; 95% CI 3.1–127.2). Mildly decreased functional ability also showed higher odds of being physically inactive compared to participants with normal functional ability (OR 4.1; 95% CI 1.1–15.6). Higher education was associated with inactivity. Fatigue, participation in physiotherapy, and participation in adapted physical activity programs were not associated with physical activity. Conclusions: Low functional ability was associated with physical inactivity in both LGMD and CMT. Association between higher education and inactivity might indicate the need to provide more understanding about physical activity benefit in this group.

• Walsem, Marleen Regina Van; Frich, Jan C; Castaneda, Monica Gomez; Howe, Emilie; Pihlstrøm, Lasse & Andelic, Nada [Vis alle 7 forfattere av denne artikkelen] (2022). Health related quality of life, service utilization and costs for patients with Huntington’s disease in Norway. BMC Health Services Research. 22(1), s. 1–12. doi: 10.1186/s12913-022-08881-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Huntington’s disease (HD) is a progressive genetic neurodegenerative disease accompanied by mental and neurocognitive disabilities, which requires long-term and comprehensive treatment and care. Information on the health and economic burden of HD is scarce, but essential for conducting health economic analyses, in light of the prospect of new therapies for HD. In this study, we aim to identify values for Health-Related Quality of Life (HRQoL), describe service utilization and costs, and their associations with clinical and socio-demographic variables across all phases of HD. Methods A cross-sectional study including 86 patients across all phases of HD. Values of HRQoL were calculated based on EQ-5D-3L index scores. Additionally, health care and societal costs were estimated based on service utilization collected using the Client Service Receipt Inventory (CSRI) and data from the patients’ interviews. Total societal costs included costs of primary and secondary health care services, informal care and productivity loss of the patients. Multiple regression analyses were used to investigate associations between socio-demographic and clinical variables on HRQoL and costs. Results HRQoL values declined, while total costs increased across disease severity. Total six-month healthcare costs and total societal costs were € 18,538 and € 66,789 respectively. Healthcare and societal costs doubled from early to middle phase, and tripled from middle to advanced disease phase. Main six-month cost components for the three disease phases were informal care costs (€ 30,605) accounting for approximately half the total societal costs, and costs due to production loss (€ 18,907) being slightly higher than the total healthcare costs. Disease severity and gender were found to have the strongest effect on both values of HRQoL and costs. Conclusions Reported values of HRQoL and costs including costs for production loss may be used in modelling the cost-effectiveness of treatment for HD. Our results highlight the crucial role the informal caregivers play in the care provided to HD patients in all disease phases. Future research should focus on the estimation of productivity loss among informal caregivers.

• Hovlid, Einar; Husabø, Gunnar; Teig, Inger Lise; Halvorsen, Kjersti & Frich, Jan C (2022). Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: a realist evaluation. Social Science and Medicine. ISSN 0277-9536. 298. doi: 10.1016/j.socscimed.2022.114872. Fulltekst i vitenarkiv Vis sammendrag

  External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers’ clinical performance over time. This will hold the organi- zation accountable for implementing improvement measures and evaluate the effects of the measures on quality of care.

• Frich, Jan C; Bratholm, Clara Sofie; Ravnestad, Håvard; Friberg, Morten Langfeldt; Mjåset, Christer & Kaarbøe, Oddvar Martin (2022). Medical leadership development during the COVID-19 pandemic. BMJ Leader. 6, s. 316–318. doi: 10.1136/leader-2021-000452. Fulltekst i vitenarkiv Vis sammendrag

  Background: A leadership development programme (The Health Leadership School) was launched in 2018 for junior doctors and medical students in Norway. Objective: To study participants’ experiences and self-assessed learning outcomes, and if there were any differences in outcome among participants who met face-to-face versus and those who had to complete half of the programme in a virtual classroom due to the COVID-19 pandemic. Methods: Participants who completed The Health Leadership School in 2018–2020 were invited to respond to a web-based questionnaire. Results: A total of 33 (83%) out of 40 participants responded. The majority of respondents (97%) somewhat agreed or strongly agreed that they had gained knowledge and skills they did not learn in medical school. Respondents reported a high learning outcome for most competency domains, and there was no difference in outcome when comparing scores of those who met face-to-face versus and those who had to complete half of the programme in a virtual classroom. Among participants who participated in virtual classroom sessions due to the COVID-19 pandemic, the majority agreed that the programme could be run as a combination of face-to-face and virtual sessions. Conclusion: This brief report suggests that leadership development programmes for junior doctors and medical students can be run in-part using virtual classroom sessions, but that face-to-face sessions are important to foster relational and teamwork skills.

• Fossberg, Bettina & Frich, Jan C (2022). Kommuneoverlegers opplevelse av egen rolle. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(2), s. 1–9. doi: 10.4045/tidsskr.21.0589. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Alle kommuner er lovpålagt å ha en kommunelege som medisinskfaglig rådgiver, men bestemmer selv organiseringen av rollen. Stillingsstørrelse, plassering og innhold varierer mellom ulike kommuner. Vi gjorde en studie for å få økt kunnskap om hvordan kommuneoverleger opplever sin egen rolle. MATERIALE OG METODE Det ble samlet data fra fokusgruppeintervjuer med 15 kommuneoverleger fra ulike kommuner og fylker. Dataene ble gjenstand for tematisk kvalitativ analyse med bruk av systematisk tekstkondensering. RESULTATER Alle kommuneoverlegene var i rådgiverfunksjoner, og mange oppga liten tilgang på formelle beslutningsarenaer. Deres opplevelse var preget av rolleuklarhet og usynlighet, men også stor grad av autonomi. De fleste kommuneoverlegene ga uttrykk for å stå i skvis mellom behovene for rådgivning på to ulike nivåer: klinisk rådgivning i enkeltsaker og overordnet samfunnsmedisinsk rådgivning til ledelsen i kommunen. Opplevelsen var tydeligere hos kommuneoverleger i større kommuner enn i små. Organisatorisk ramme og forventninger fra ledelsen bidro til overvekt av etterspørsel etter klinisk rådgivning. Dette begrenset utviklingen av en samfunnsmedisinsk identitet og rolleutøvelse. FORTOLKNING Kommuneoverleger står i en hybridrolle som rådgivere på ulike nivåer som krever ulike identiteter. For å styrke den samfunnsmedisinske utøvelsen må rollen tydeliggjøres gjennom organisatoriske rammer og forventninger i kommunen.

• Lyons, Oscar; George, Robynne; Galante, Jao R.; Mafi, Alexander; Fordwoh, Thomas & Frich, Jan C [Vis alle 7 forfattere av denne artikkelen] (2021). Evidence-based medical leadership development: a systematic review. BMJ Leader. 5, s. 206–213. doi: 10.1136/leader-2020-000360. Fulltekst i vitenarkiv Vis sammendrag

  Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

• Solbakken, Gro; Løseth, Sissel; Johanessen, Anne Froholdt; Eikeland, Torunn; Nærland, Terje & Frich, Jan C [Vis alle 8 forfattere av denne artikkelen] (2021). Pain in adult myotonic dystrophy type 1: relation to function and gender. BMC Neurology. 21(1), s. 1–11. doi: 10.1186/s12883-021-02124-9. Fulltekst i vitenarkiv Vis sammendrag

  <i>Background</i> - Pain is prevalent in myotonic dystrophy 1 (DM1). This study investigated whether CTG repeat size, disease duration, BMI and motor and psychological function were related to pain in adult patients with DM1, and if there were gender differences regarding intensity and location of pain.<br><br> <i>Method</i> - Cross-sectional design. Pain was investigated in 50 genetically confirmed DM1 patients by combining clinical assessment and self-reports of pain intensity and locations. Pain scoring results were related to CTG size, disease duration, muscle strength, walking capacity measured by 6-min walk test, activity of daily life by Katz ADL Index, respiratory function by Forced Vital Capacity and BMI. In addition, the degree of reported pain was related to Quality of life measured by WHOQOL-BREF; fatigue was measured by Fatigue severity scale; psychological functions were measured by Beck Depression Inventory, Beck Anxiety Inventory, IQ and Autism spectrum Quotient.<br><br> <i>Results</i> - Pain was reported in 84% of the patients and was significantly correlated with CTG size (<i>r </i>= 0.28 <i>p</i> = 0.050), disease duration (<i>r</i> = 0.38 <i>p</i> = 0.007), quality of life (<i>r</i> = − 0.37 <i>p</i> = 0.009), fatigue (<i>r</i> = 0.33 <i>p</i> = 0.02) and forced vital capacity (<i>r</i> = − 0.51, <i>p</i> = 0.005). Significant gender differences, with higher scores for females, were documented. In male subjects the number of pain locations was significantly correlated with quality of life and the autism quotient. In females, pain intensity was significantly correlated with activity, respiratory function and BMI.<br><br> <i>Conclusions</i> - Pain in DM1 was prevalent, with a strong association to lung function and other aspects of the disease. Significant gender differences were present for pain intensity and number of pain locations. How pain was related to other symptoms differed between male and female subjects. Our findings highlight the importance of assessments of pain in DM1 patients.

• Kristoffersen, Espen Saxhaug; Faiz, Kashif Waqar; Hansen, Jakob Møller; Tronvik, Erling Andreas; Frich, Jan C & Lundqvist, Christofer [Vis alle 7 forfattere av denne artikkelen] (2021). The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey. The Journal of Headache and Pain. ISSN 1129-2369. 22(1), s. 1–11. doi: 10.1186/s10194-021-01350-3. Fulltekst i vitenarkiv Vis sammendrag

  Background General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. Methods We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. Results 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. Conclusion The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.

• Husabø, Gunnar; Teig, Inger Lise; Frich, Jan C; Bondevik, Gunnar Tschudi & Hovlid, Einar (2020). Promoting leadership and quality improvement through external inspections of management of sepsis in Norwegian hospitals: a focus group study. BMJ Open. 10:e041997(11), s. 1–9. doi: 10.1136/bmjopen-2020-041997. Fulltekst i vitenarkiv Vis sammendrag

  Objective Inspections and other forms of external assessment may contribute to positive changes in the health services, but the mechanisms of such change remain unclear. We did a study to explore how external inspections may foster clinical improvement in hospitals. Design Focus group study. Setting Statutory inspections of sepsis treatment in hospital emergency departments in Norway. Participants Clinicians, managers and inspection teams involved with the inspections of sepsis treatment in emergency departments at four different hospitals. Twelve focus group interviews were carried out, with a total of 47 participants. Results Three themes emerged as central for understanding how the inspections could contribute to clinical improvement in the emergency departments: (1) increasing awareness about the need to improve the quality of care by providing data on clinical performance, (2) building acceptance for improvement through professional credibility and focus on clinical practice, and (3) fostering leadership commitment. Conclusion Our findings suggest that the inspections have the potential to enhance hospital management and staff’s understanding of complicated care processes and help strengthen the organisational commitment to bring about systemic quality improvements.

• Ikram, Umar; Ren, Hui; Shields-Zeeman, Laura; Frich, Jan C; Jones, Daniel Northam & Wu, Jiong [Vis alle 9 forfattere av denne artikkelen] (2020). Balancing COVID-19 preparedness and ‘business as usual’ in hospitals:lessons from executives in China, Norway and the UK. BMJ Leader. 5(2), s. 130–133. doi: 10.1136/leader-2020-000314. Fulltekst i vitenarkiv
• Husabø, Gunnar; Nilsen, Roy Miodini; Solligård, Erik; Flaatten, Hans; Walshe, Kieran & Frich, Jan C [Vis alle 11 forfattere av denne artikkelen] (2020). Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation. BMJ Open. 10(10). doi: 10.1136/bmjopen-2020-037715. Fulltekst i vitenarkiv Vis sammendrag

  Objective To evaluate the effects of external inspections on (1) hospital emergency departments’ clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality. Design Incomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis. Setting Nationwide inspections of sepsis care in emergency departments in Norwegian hospitals. Participants 7407 patients presenting to hospital emergency departments with sepsis. Intervention External inspections of sepsis detection and treatment led by a public supervisory institution. Main outcome measures Process measures for sepsis diagnostics and treatment, length of hospital stay and 30-day all-cause mortality. Results After the inspections, there were significant improvements in the proportions of patients examined by a physician within the time frame set in triage (OR 1.28, 95% CI 1.07 to 1.53), undergoing a complete set of vital measurements within 1 hour (OR 1.78, 95% CI 1.10 to 2.87), having lactate measured within 1 hour (OR 2.75, 95% CI 1.83 to 4.15), having an adequate observation regimen (OR 2.20, 95% CI 1.51 to 3.20) and receiving antibiotics within 1 hour (OR 2.16, 95% CI 1.83 to 2.55). There was also significant reduction in mortality and length of stay, but these findings were no longer significant when controlling for time. Conclusions External inspections were associated with improvement of sepsis detection and treatment. These findings suggest that policy-makers and regulatory agencies should prioritise assessing the effects of their inspections and pay attention to the mechanisms by which the inspections might contribute to improve care for patients.

• Hovlid, Einar; Braut, Geir Sverre; Hannsidal, Einar; Walshe, Kieran; Bukve, Oddbjørn & Flottorp, Signe Agnes [Vis alle 8 forfattere av denne artikkelen] (2020). Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open. 10, s. 1–33. doi: 10.1136/bmjopen-2020-038850. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections. Methods: We performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change. Results: We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance. Conclusions: External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.

• Andries, Aristomo; Walsem, Marleen Regina Van & Frich, Jan C (2020). Self-reported physical activity in people with limb-girdle muscular dystrophy and Charcot-Marie-Tooth disease in Norway. BMC Musculoskeletal Disorders. 21(235). doi: 10.1186/s12891-020-03246-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Physical activity is associated with positive health effects, but individuals with neuromuscular disease (NMD) may experience constraints being physically active. There is a gap in the literature on the activity level of people with NMDs, and therefore we did a study to determine the physical activity level in people with Limb-Girdle muscular dystrophy (LGMD) and Charcot-Marie-Tooth disease (CMT). Methods This study used a cross-sectional design to obtain self-reported physical activity and sitting time among individuals with LGMD and CMT who were recruited from the Norwegian registry for hereditary and congenital neuromuscular diseases. Results A total of 127 respondents who filled out questionnaires about either physical activity or sitting time were included in the analysis. Seventy (55.1%) had a diagnosis of CMT and 57 (44.9%) had a diagnosis of LGMD. Seventy-three (57.5%) respondents were female and 54 (42.5%) were male. Among the 108 respondents with available physical activity data, 44.4% reported being physically inactive. Among the 109 respondents with available sitting time data, the average sitting time was 8.6 h. Longer sitting time was associated with higher physical inactivity. Conclusion Among people with LGMD and CMT in our study, 55.6% reported being physically active. Respondents with LGMD and CMT reported longer sitting time and less physical activity compared with healthy respondents in other studies. Further research should explore variables and measures that can promote physical activity among people with neuromuscular conditions.

• Martinussen, Pål Erling; Magnussen, Jon; Vrangbæk, Karsten & Frich, Jan C (2020). Should I stay or should I go? The role of leadership and organisational context for hospital physicians’ intention to leave their current job. BMC Health Services Research. 20(400). doi: 10.1186/s12913-020-05285-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Physician turnover is a concern in many health care systems globally. A better understanding of physicians’ reasons for leaving their job may inform organisational policies to retain key personnel. The aim of this study was to investigate hospital physicians’ intention to leave their current job, and to investigate if such intentions are associated with how physicians assess their leaders and the organisational context. Methods Data was derived from a survey of 971 physicians working in public hospitals in Norway in 2016. The data was analysed using descriptive statistics and multivariate analysis. Results We found that 21.0% of all hospital physicians expressed an intention to leave their current job for another job. An additional 20.3% of physicians had not made up their mind whether to stay or leave. Physicians’ perceptions of their leaders and the organisational context influence their intention to leave their hospital. Respondents who perceived their leaders as professional-supportive had a significantly lower probability of reporting an intention to leave their job. The analysis suggests that organisational context, such as department mergers, weigh in on physicians’ considerations about leaving their current job. Social climate and commitment are important reasons why physician stay. Conclusions A professional-supportive leadership style may have a positive influence on retention of physicians in public hospitals. Further research should investigate how retention of physicians is associated with performance related to organisational and leadership style.

• Husabø, Gunnar; Nilsen, Roy Miodini; Flaatten, Hans; Solligård, Erik; Frich, Jan C & Bondevik, Gunnar Tschudi [Vis alle 10 forfattere av denne artikkelen] (2020). Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PLOS ONE. 15(1), s. 1–15. doi: 10.1371/journal.pone.0227652. Fulltekst i vitenarkiv Vis sammendrag

  Background Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients. The second objective was to estimate associations between diagnostic procedures and time to antibiotic treatment, and to estimate associations between time to antibiotic treatment and mortality. Methods This observational study from 24 emergency departments in Norway included 1559 patients with infection and at least two systemic inflammatory response syndrome criteria. We estimated associations using linear and logistic regression analyses. Results Of the study patients, 72.9% (CI 70.7–75.1) had documented triage within 15 minutes of presentation to the emergency departments, 44.9% (42.4–47.4) were examined by a physician in accordance with the triage priority, 44.4% (41.4–46.9) were adequately observed through continual monitoring of signs while in the emergency department, and 25.4% (23.2–27.7) received antibiotics within 1 hour. Delay or non-completion of these key diagnostic procedures predicted a delay of more than 2.5 hours to antibiotic treatment. Patients who received antibiotics within 1 hour had an observed 30-day all-cause mortality of 13.6% (10.1–17.1), in the timespan 2 to 3 hours after admission 5.9% (2.8–9.1), and 4 hours or later after admission 10.5% (5.7–15.3). Conclusions Key procedures for recognizing sepsis were delayed or not completed in a substantial proportion of patients admitted to the emergency department with sepsis. Delay or non-completion of key diagnostic procedures was associated with prolonged time to treatment with antibiotics. This suggests a need for systematic improvement in the initial management of patients admitted to emergency departments with sepsis.

• Hovlid, Einar; Teig, Inger Lise; Halvorsen, Kjersti & Frich, Jan C (2020). Inspecting teams' and organisations' expectations regarding external inspections in health care: a qualitative study. BMC Health Services Research. 20. doi: 10.1186/s12913-020-05475-0. Fulltekst i vitenarkiv Vis sammendrag

  Background There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body’s site visit. This study aimed to explore inspecting bodies’ expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits. Methods This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method. Results We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations’ leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards. Conclusions To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.

• Solbakken, Gro; Bjørnarå, Bård; Kirkhus, Eva Astrid; Nguyen, Bac; Hansen, Gunnar & Frich, Jan C [Vis alle 7 forfattere av denne artikkelen] (2019). MRI of trunk muscles and motor and respiratory function in patients with myotonic dystrophy type 1. BMC Neurology. 19, s. 1–11. doi: 10.1186/s12883-019-1357-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Myotonic Dystrophy 1 (DM1) causes progressive myopathy of extremity muscles. DM1 may also affect muscles of the trunk. The aim of this study was to investigate fat infiltration and muscle size in trunk muscles in DM1 patients, and in an age and gender matched control group. Further, explore how fat infiltration and degree of atrophy in these muscles are associated with motor and respiratory function in DM1 patients. Method We measured fat infiltration and trunk muscle size by MRI in 20 patients with genetically confirmed classic form of DM1, and compared these cases with 20 healthy, age and gender matched controls. In the DM1 group, we investigated correlations between MRI findings and clinical measures of muscle strength, mobility and respiration. We used sum scores for fat infiltration and muscle size in trunk flexors and trunk extensors in the analysis of group differences and correlations. Results Significant differences between cases and controls were present for fat infiltration in trunk flexors (p = 0.001) and trunk extensors (p = < 0.001), and for muscle size in trunk flexors (p = 0.002) and trunk extensors (p = 0.030). Fat infiltration in trunk flexors were significant correlated to back extension strength (rho = − 0.523 p = 0.018), while muscle size in trunk flexors was significantly correlated to trunk flexion strength (rho = 0.506 p = 0.023). Fat infiltration in trunk flexors was significantly correlated with lower general mobility (rho = − 0.628, p = 0.003), reduced balance (rho = 0.630, p < 0.003) and forced vital capacity (rho − 0.487 p = 0.040). Conclusions Trunk muscles in DM1 patients had significant higher levels of fat infiltration and reduced muscle size compared to age and gender matched controls. In DM1 patients, fat infiltration was associated with reduced muscle strength, mobility, balance and lung function, while muscle size was associated with reduced muscle strength and lung function. These findings are of importance for clinical management of the disease and could be useful additional outcome measures in future intervention studies.

• Schwartz, Anna; Walsem, Marleen Regina Van; Brean, Are & Frich, Jan C (2019). Therapeutic use of music, dance, and rhythmic auditory cueing for patients with Huntington's disease: a systematic review. Journal of Huntington's Disease. ISSN 1879-6397. 8(4), s. 393–420. doi: 10.3233/JHD-190370. Fulltekst i vitenarkiv Vis sammendrag

  Background: Studies have assessed the therapeutic effect of music, dance, and rhythmic auditory cueing for patients with Huntington’s disease (HD). However, the synthesis of evidence in support of their positive impact on symptoms is lacking. Objective: We conducted a systematic literature review to evaluate the potential benefits of music, dance, and rhythm on the cognitive, psychiatric and motor function in patients with HD. Methods: Two- and three-keyword searches and a manual search identified medical literature published from 1999 through 2019. We considered literature that assessed outcomes of art-based rehabilitation programs or individual modalities for persons with early, middle, or advanced HD. Structured analysis was conducted using data entry tables with categories for patient health status, art methods, and outcomes. Results: Seven articles and six abstracts met eligibility criteria, of which nine evaluated art-based rehabilitation programs. Studies mainly assessed cognitive, psychiatric, and motor functions through music, dance, or rhythm modalities. Although results were conflicting, in summary improvements to motor function were dependent on disease severity and more responsive to art therapy programs than rhythm-motor synchronization. Benefits to global cognition that resulted from rhythmic training correlated with microstructural changes. Qualitative data verified a positive impact on language production, chorea, behavior, and quality of life. Conclusions: Our review has shown a potential benefit of music, dance, and rhythm for patients with HD, which is particularly important for a disease that has no cure. Art forms seemed to affect cognitive, psychiatric, motor, psychosocial, and neuroanatomical domains. However, evidence is preliminary, warranting further investigation to establish the foundation for this field.

• Frich, Jan C (2018). Eugene O’Neills Strange Interlude – et nevrolitterært perspektiv. Michael. ISSN 1893-9651. 15, s. 98–106. Fulltekst i vitenarkiv Vis sammendrag

  Eugene O’Neill var amerikansk dramatiker som i 1923 ferdigstilte manuset til dramaet Strange Interlude. Dramaet som ble oppført i 1928 tematiserer spenninger mellom individuell lykke, lyst og sosiale forpliktelser. En sykdom har rammet slekten til Sam Evans, en av hovedpersonene. Hvilken sykdom er det som skildres? Hvordan kan stykket forstås som et innlegg i en større debatt om enkeltmenneskets ansvar i relasjon til arvelige sykdommer? Artikkelen baserer seg på en nærlesning av teksten og gjennomgang av vitenskapelig litteratur om O’Neill og dramaets samtid. Huntingtons sykdom kan ha vært en modell som fungerte rent dramaturgisk for en mer bred ide om «hereditary insanity».

• Walsem, Marleen Regina van; Piira, Anu Mirjam; Mikalsen, Geir; Fossmo, Hanne Ludt; Howe, Emilie & Knutsen, Synnøve Fønnebø [Vis alle 7 forfattere av denne artikkelen] (2018). Cognitive performance after a one-year multidisciplinary intensive rehabilitation program for Huntington’s disease: an observational study. Journal of Huntington's Disease. ISSN 1879-6397. 7(4), s. 379–389. doi: 10.3233/JHD-180294. Fulltekst i vitenarkiv Vis sammendrag

  Background: Studies of physical therapy and multidisciplinary rehabilitation programs for Huntington’s disease (HD) have shown improvements in gait function, balance, and physical quality of life. There is a gap in the literature on effects of cognitive interventions and the potential to improve cognitive performance. Objective: To assess changes in cognitive performance among patients with early to middle stage HD as secondary analyses from a one-year multidisciplinary rehabilitation program. The program included cognitive stimulation as a non-specific cognitive intervention in addition to physical interventions. Methods: A one-year rehabilitation program that included comprehensive neuropsychological assessments was completed by 31 out 37 participants with early to middle stages of HD. Socio-demographic and clinical information was recorded. A battery of neuropsychological tests was used to measure cognitive functions before and after the intervention. Descriptive statistics was used for sample characteristics. Paired sample t-tests and nonparametric Wilcoxon Signed ranked tests were used to compare cognitive measures at both time points. Results: Scores on the Symbol Digit Modalities Test (SDMT) were significantly lower post intervention. There were no significant differences in all other measures. Scores on the Stroop color naming and California Verbal Learning Test-II (CVLT-II) long-term delayed recall tasks showed tendencies towards lower scores post intervention. Conclusions: An intensive multidisciplinary rehabilitation program for patients with HD was generally well tolerated and feasible, with no indication of negative effects on cognition. Neuropsychological measures overall remained stable following an intensive multidisciplinary rehabilitation program, however continued progression of cognitive impairment was evident on the SDMT, suggesting that disease progression is not halted. Randomized controlled trials are needed to verify these findings.

• Frich, Jan C & Spehar, Ivan (2018). Physician leadership development: towards multidisciplinary programs? BMJ Leader. 2, s. 91–94. doi: 10.1136/leader-2018-000070. Fulltekst i vitenarkiv Vis sammendrag

  Background: The format and content of leadership development programmes for physicians is a theme for discussion in the literature. Objectives: The aim of this study is to explore healthcare executives’ perspectives on physician leadership development, focusing on perceived benefits and negative effects associated with multidisciplinary programmes. Methods: We did a qualitative study based on data from semistructured interviews with 16 healthcare executives in US healthcare systems. Results: We found that one group perceived programmes targeting one profession as advantageous, promoting openness and professional relationships among peers. Other executives argued that multidisciplinary programmes could add value because they could bridge professional boundaries, strengthen networks and build leadership capacity throughout an organisation. Costs, timing, organisational culture and a lack of knowledge about how to run multidisciplinary programmes were challenges our informants associated with multidisciplinary leadership development programmes. Conclusion: This study identifies topics and challenges that can inform organisational policies and decisions about leadership development activities.

• Vassbotn, Ane Drougge; Sjøvik, Hege; Tjerbo, Trond; Frich, Jan C & Spehar, Ivan (2018). General practitioners' perspectives on care coordination in primary health care: A qualitative study. International Journal of Care Coordination. ISSN 2053-4345. 21(4), s. 153–159. doi: 10.1177/2053434518816792. Fulltekst i vitenarkiv Vis sammendrag

  Introduction To explore Norwegian general practitioners’ experiences with care coordination in primary health care. Methods Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner’s role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality. Discussion General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.

• Solberg, Olga; Filkukova, Petra; Frich, Jan C & Feragen, Kristin Judith Billaud (2018). Age at Death and Causes of Death in Patients with Huntington Disease in Norway in 1986-2015. Journal of Huntington's Disease. ISSN 1879-6397. 7(1), s. 77–86. doi: 10.3233/JHD-170270. Fulltekst i vitenarkiv Vis sammendrag

  Background: The literature offers discrepant findings regarding age at death in individuals with Huntington disease (HD). Objective: To study the age at death and causes of death in males and females with a diagnosis of HD in Norway. Methods: Registry study of deaths in 1986–2015 using data from two national registries: the Norwegian Cause of Death Registry (NCDR) and the registry of the Centre for Rare Disorders (CRD), Oslo University Hospital. Results: Mean age at death for individuals with HD was found to be 63.9 years (NCDR) and 61.7 years (CRD), compared to a mean of 76.9 years in the general population (NCDR). There were no significant gender differences for age at death in individuals with HD. The significant increase in age at death within the general population from 1986 to 2015 was not observed in individuals with HD. In 73.5% of individuals with HD, the underlying cause of death was HD, followed by cardiovascular diseases, cancer and respiratory diseases. The most common immediate cause of death was respiratory diseases (44.2%). Suicide was a more common cause of death in the population with HD (2.3%) compared to the general population (1.3%). Conclusion: The age at death of individuals with HD was stable over a period of 30 years and 13.3 years lower than in the general population. Longer life expectancy for females from the general population was not found in females with HD. Suicide was more common among individuals with HD compared to the general population.

• Ofstad, Eirik Hugaas; Frich, Jan C; Schei, Edvin; Frankel, Richard M.; Benth, Jūratė Šaltytė & Gulbrandsen, Pål (2018). Clinical decisions presented to patients in hospital encounters: a cross-sectional study using a novel taxonomy. BMJ Open. 8, s. 1–9. doi: 10.1136/bmjopen-2017-018042. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To identify and classify all clinical decisions that emerged in a sample of patient–physician encounters and compare different categories of decisions across clinical settings and personal characteristics. Design: Cross-sectional descriptive evaluation of hospital encounters videotaped in 2007–2008 using a novel taxonomy to identify and classify clinically relevant decisions (both actions and judgements). Participants and setting: 372 patients and 58 physicians from 17 clinical specialties in ward round (WR), emergency room (ER) and outpatient (OP) encounters in a Norwegian university hospital. Results: The 372 encounters contained 4976 clinically relevant decisions. The average number of decisions per encounter was 13.4 (min–max 2–40, SD 6.8). The overall distribution of the 10 topical categories in all encounters was: defining problem: 30%, evaluating test result: 17%, drug related: 13%, gathering additional information: 10%, contact related: 10%, advice and precaution: 8%, therapeutic procedure related: 5%, deferment: 4%, legal and insurance related: 2% and treatment goal: 1%. Across three temporal categories, the distribution of decisions was 71% here-and-now, 16% preformed and 13% conditional. On average, there were 15.7 decisions per encounter in internal medicine specialties, 7.1 in ear–nose–throat encounters and 11.0–13.6 in the remaining specialties. WR encounters contained significantly more drug-related decisions than OP encounters (P=0.031) and preformed decisions than ER and OP encounters (P<0.001). ER encounters contained significantly more gathering additional information decisions than OP and WR encounters (P<0.001) and fewer problem defining decisions than WR encounters (P=0.028). There was no significant difference in the average number of decisions related to the physician’s and patient’s age or gender. Conclusions: Patient–physician encounters contain a larger number of clinically relevant decisions than described in previous studies. Comprehensive descriptions of how decisions, both as judgements and actions, are communicated in medical encounters may serve as a first step in assessing clinical practice with respect to efficiency and quality on a provider or system level.

• Frich, Jan C (2018). Henrik Ibsen's Battle With Cerebrovascular Disease. I Bogousslavsky, Julien & Tatu, Laurent (Red.), Neurological Disorders in Famous Artists - Part 4. S. Karger. ISSN 9783318063936. s. 139–145. doi: 10.1159/000490444. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Vaktskifte ved Nevrologisk avdeling, Oslo. Tidsskrift for Huntingtons sykdom. Fulltekst i vitenarkiv
• Jakobsen, Rune Bruhn; Gran, Sarah Frandsen; Grimsmo, Bergsvein; Arntzen, Kari; Fosse, Erik & Frich, Jan C [Vis alle 7 forfattere av denne artikkelen] (2018). Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. Journal of Interprofessional Care. ISSN 1356-1820. 32(1), s. 80–88. doi: 10.1080/13561820.2017.1376625. Fulltekst i vitenarkiv Vis sammendrag

  High quality care relies on interprofessional teamwork. We developed a short simulation-based course for final year medical, nursing and nursing anaesthesia students, using scenarios from emergency medicine. The aim of this paper is to describe the adaptation of an interprofessional simulation course in an undergraduate setting and to report participants’ experiences with the course and students’ learning outcomes. We evaluated the course collecting responses from students through questionnaires with both closed-ended and open-ended questions, supplemented by the facilitators’ assessment of students’ performance. Our data is based on responses from 310 students and 16 facilitators who contributed through three evaluation phases. In the analysis, we found that students reported emotional activation and learning outcomes within the domains self-insight and stress management, understanding of the leadership role, insight into teamwork, and skills in team communication. In subsequent questionnaire studies students reported having gained insights about communication, teamwork and leadership, and they believed they would be better leaders of teams and/or team members after having completed the course. Facilitators’ observations suggested a progress in students’ non-technical skills during the course. The facilitators observed that nursing anaesthesia students seemed to be more comfortable in finding their role in the team than the two other groups. In conclusion, we found that an interprofessional simulation-based emergency team training course with a focus on leadership, communication and teamwork, was feasible to run on a regular basis for large groups of students. The course improved the students’ team skills and received a favourable evaluation from both students and faculty.

• Lippe, Charlotte von der; Frich, Jan C; Harris, Anna & Solbrække, Kari Nyheim (2017). “It was a lot tougher than I thought it would be”: A qualitative study on the changing nature of being a hemophilia carrier. Journal of Genetic Counseling. ISSN 1059-7700. 26(6), s. 1324–1332. doi: 10.1007/s10897-017-0112-9. Fulltekst i vitenarkiv
• Frich, Jan C; Sjøvik, Hege & Spehar, Ivan (2017). Leder- og ledelsesutvikling i helsevesenet – en oversikt. Michael. ISSN 1893-9651. 14, s. 168–176. Fulltekst i vitenarkiv Vis sammendrag

  Artikkelen omhandler tilnærminger til leder- og ledelsesutvikling i helsevesenet. Vi vil definere begrepene lederutvikling og ledelsesutvikling, peke på betydningen av å tydeliggjøre forventet læringsutbytte, presentere ulike typer tiltak og aktiviteter, diskutere styrker og svakheter ved interne og eksterne program, før vi gjør rede for kunnskapsstatus om effekter av lederutvikling. I litteraturen er det vanlig å skille mellom tiltak og aktiviteter rettet inn mot å utvikle enkeltindivider (lederutvikling) versus grupper eller organisasjoner (ledelsesutvikling). Tiltak og aktiviteter kan inndeles i fem kategorier: Utviklende relasjoner, utviklende oppgaver, tilbakemelding, formelle program og egenutviklingsaktiviteter. Det er dokumentert at leder- og ledelsesutvikling er assosiert med positive resultater, men det er behov for mer forskning om hvilke typer program, tiltak og aktiviteter som er hensiktsmessige.

• Martinussen, Pål Erling; Frich, Jan C; Vrangbæk, Karsten & Magnussen, Jon (2017). Organisatoriske forhold og løsninger i spesialisthelsetjenesten – hva mener sykehuslegene? Michael. ISSN 1893-9651. 14, s. 95–105. Fulltekst i vitenarkiv Vis sammendrag

  Det er gjort få forsøk på å kartlegge hva sykehuslegene mener om dagens styring og organisering av spesialisthelsetjenesten. Vi gjennomførte en spørreundersøkelse blant 971 medlemmer av Overlegeforeningen og Yngre legers forening i Legeforeningen for å belyse følgende spørsmål: Hvilke oppfatninger har sykehusleger av ulike organisatoriske forhold og løsninger i dagens sykehusorganisering? Hvilke endringer av dagens modell mener sykehusleger vil være gunstig? Samlet sett synes norske sykehusleger å være skeptiske til den nåværende modell og en god del av legene mener at den tidligere fylkeskommunale forvaltningsmodellen vil være å foretrekke. Våre resultater indikerer at sykehusleger ønsker mer lokal ledelse, kortere beslutningsveier, mindre incentivbasert styring og bedre ITsystemer. Legene vil ikke ha politisk innblanding i driftsmessige spørsmål, men kan akseptere at politikere treffer beslutninger i større saker. Respondenter med lederansvar hadde signifikant lavere sannsynlighet for å betrakte både foretaksmodellen, fravær av stedlig ledelse og samling av avdelingen som problematisk sammenliknet med leger uten en lederrolle. En rekke aspekter ved dagens styringsmodell oppleves som mer problematisk i Helse Sør-Øst enn i de øvrige regionene. Undersøkelsen indikerer at sykehusleger ønsker seg tilbake til en sektor som i sterkere grad enn i dag er profesjonsstyrt.

• Walsem, Marleen Regina van; Howe, Emilie; Ruud, Gunvor Aslaksen; Frich, Jan C & Andelic, Nada (2017). Health-related quality of life and unmet healthcare needs in Huntington's disease. Health and Quality of Life Outcomes. 15(6), s. 1–10. doi: 10.1186/s12955-016-0575-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Huntington’s disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients’ needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. Methods In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington’s Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients’ HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. Results The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to higher HRQoL (β value 0.564; p < 0.001). Conclusions The study findings suggest that patients with HD do not receive healthcare services that could have a positive impact on their HRQoL.

• Lerum, Sverre Vigeland; Solbrække, Kari Nyheim & Frich, Jan C (2017). Healthcare professionals’ accounts of challenges in managing motor neurone disease in primary health care: a qualitative study. Health and Social Care in the Community. ISSN 0966-0410. 25(4), s. 1355–1363. doi: 10.1111/hsc.12432. Fulltekst i vitenarkiv
• Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug & Frich, Jan C (2017). General practitioners' views on leadership roles and challenges in primary health care: a qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 35(1), s. 105–110. doi: 10.1080/02813432.2017.1288819. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design: We conducted focus groups (FGs) with 17 GPs. Setting: Norwegian primary health care. Subjects: 17 GPs who attended a 5 d course on leadership in primary health care. Results: Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement. Conclusions: GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance.

• Lippe, Charlotte von der; Frich, Jan C; Harris, Anna & Solbrække, Kari Nyheim (2017). Treatment of hemophilia: A qualitative study of mothers’ perspectives. Pediatric Blood & Cancer. ISSN 1545-5009. 64, s. 121–127. doi: 10.1002/pbc.26167. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Frich, Jan C & Nylenna, Magne (2025). The Harkness fellowship – the Norwegian experience. Michael. ISBN 9788292871706. 100 s. Fulltekst i vitenarkiv
• Frich, Jan C; Brean, Are & Dietrichs, Espen (2024). Hjernen og mytene. Michael. ISBN 9788292871713. 216 s. Fulltekst i vitenarkiv
• Frich, Jan C; Brean, Are & Dietrichs, Espen (2018). Hjernen og historien. Michael. ISBN 9788292871843. 144 s. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Tjomsland, Ole; Thoresen, Christian; Ingebrigtsen, Tor; Jensen, Jens W; Møller, Henrik & Frich, Jan C [Vis alle 8 forfattere av denne artikkelen] (2026). Norwegian clinical dashboard: updated and expanded versions may lead to further Nordic collaboration. BMJ Leader. doi: 10.1136/leader-2026-001581. Fulltekst i vitenarkiv
• Frich, Jan C; Louiset, Mathieu; Koeijer, Relinde de; Vanhaecht, Kris; Phillipson, Juliette & Elnes, Anniken Riise (2026). E4: Building leaders for improvement: evidence, experience and emerging voices. doi: https:/internationalforum.bmj.com/oslo/2025/10/16/e4-building-leaders-for-improvement-evidence-experience-and-emerging-voices/. Fulltekst i vitenarkiv
• Frich, Jan C; Patel, Dharaa; Newitt, Simon; Egsgaard-Toft, Malene & Hjorhöy, Liv Gølnitz (2026). D3: Less is more: lessons from de-implementing low-value work in healthcare. doi: https:/internationalforum.bmj.com/oslo/2025/10/15/d3-less-is-more-lessons-from-de-implementing-low-value-work-in-healthcare/. Fulltekst i vitenarkiv Vis sammendrag

  In healthcare, some practices persist long after the evidence against them is clear. These “zombie ideas”- guidelines, tasks, or treatments that refuse to die - consume time, resources, and energy without benefiting patients or staff. This session explores the vital work of de-implementation: how to detect and dismantle low-value practices, challenge entrenched routines, and create space for care that truly matters and build competencies and culture around de-implementation. Through practical experiences, participants will learn how to: Recognize and detect “zombie ideas” that linger despite evidence. Systematically identify and stop low-value guidelines and tasks, leading systematic de-implementation. Engage patients and staff in questioning what does not add value. Build a culture where removing harmful or useless practices is celebrated as progress. Part 1: Zombie Leadership: burying the ideas in health and care that just won't die. In the shadows of the health and care system lurk leadership ideas that refuse to die. Join us for an interactive session exploring these 'zombie' ideas from a bygone world; ideas that infect today's workplace cultures and spoil all attempts at a better tomorrow. But spotting a 'zombie' idea is only half the battle - what's the antidote? We'll offer a perspective on leadership that is more human, realistic and evidence-based. A type of leadership that lives in the everyday experience of work, of colleagues helping, supporting and developing one another. A collective type of leadership capable of shifting the future of work and slaying old ideas. Drawing from The King's Fund's ShiftWorks online learning movement, this session demonstrates how distributed leadership can emerge from anywhere in the health and care workforce. Through interactive exercises, participants will identify zombie ideas in their own organisations and discover practical tools for fostering peer-driven, collective leadership that breaks the patterns of the past. Dharaa Patel Development Consultant, The King's Fund; UK Simon Newitt Development Consultant, The King's Fund; UK Part 2: Leading de-implementation in healthcare: why is it so difficult to stop doing what doesn't work? Worldwide, healthcare systems face the challenge of focusing resources on what truly matters and provides value. Despite identifying wasteful practices, we are notoriously ineffective at discontinuing them. We seem to struggle more with de-implementing interventions than with implementing new initiatives. Why is this the case? Given these challenges, this session will explore how healthcare leaders can eliminate the unnecessary, especially under the pressures of an aging population and increasing chronic diseases. We will present challenges from organizational, clinical, and lived-experience perspectives. Through real-life examples and participant involvement, we aim to define the elements required for successful de-implementation. Malene Egsgaard-Toft Operational Quality and Patient Safety Lead, Region Zealand; Denmark Liv Gølnitz Hjorhöy Senior Consultant, Region Zealand; Denmark

• Lofthus, Cathrine Marie & Frich, Jan C (2025). Innovation and preparedness: navigating future crisis. Fulltekst i vitenarkiv
• Frich, Jan C (2025). Prioriteringens dilemmaer. Fulltekst i vitenarkiv Vis sammendrag

  Prioritering handler om å bruke ressursene i helsetjenesten på en best mulig måte innenfor de rammene Stortinget har bestemt.

• Frich, Jan C (2025). Kloke valg 2.0. Fulltekst i vitenarkiv Vis sammendrag

  Vi må arbeide på lag hvis vi skal lykkes med å gjøre kloke valg og unngå unødvendige helsetjenester, og derfor er etableringen av Kloke valg-sykehus et skritt i riktig retning.

• Frich, Jan C; Nylenna, Magne; Telle, Kjetil Elias; Flottorp, Signe Agnes & Røttingen, John-Arne (2025). The Norwegian Harkness-experience 2010–2025. I Frich, Jan C & Nylenna, Magne (Red.), The Harkness fellowship – the Norwegian experience. Michael. ISSN 9788292871706. s. 10–20. doi: 10.56175/Michael.12577. Fulltekst i vitenarkiv Vis sammendrag

  he Harkness Fellowships, offered by The Commonwealth Fund, provide midcareer professionals from selected countries—including Norway—with a year-long opportunity to conduct health policy research in the U.S. The program aims to develop international leaders by fostering comparative research and collaboration across health systems. Fellows are placed at leading U.S. institutions, engage with mentors, participate in seminars, site visits, and policy briefings, and present their findings at a final seminar. Since Norway joined the program in 2010, 14 Norwegian fellows have completed the program, supported by the Norwegian Knowledge Centre for Health Services, the Norwegian Institute of Public Health and the Research Council of Norway. The Norwegian fellows have explored a wide range of topics including equity, overdiagnosis, telemedicine, and care for chronic conditions. They report that the program fosters both professional and personal development, new research collaborations, and lasting networks. Their contributions have enriched Norwegian health services research and policy through publications, policy advice, and policy and practice innovation. The program is considered a valuable source of international perspective and leadership development for improving health care systems.

• Saunes, Ingrid Sperre & Frich, Jan C (2025). Policies addressing delayed discharges from hospital in Norway. European Journal of Public Health. ISSN 1101-1262. 35(4), s. iv115–iv116. doi: 10.1093/eurpub/ckaf161.277. Fulltekst i vitenarkiv Vis sammendrag

  Background: Two recent initiatives in Norway that aim to address delayed discharges are the establishment of municipal emergency care beds and the formation of formal partnerships (Health Communities) between hospitals and the municipalities within their catchment area. Methods: A review of academic and grey literature, media reports and relevant organisational websites. Results: Since 2016, municipalities have provided municipal emergency inpatient care (as well as emergency outpatient care). Municipal emergency care beds are intended for short-term stays of a maximum of three days, allowing the municipality to organise necessary measures before the patient is transferred to their permanent residence (whether it is a private home, shared living facilities or a nursing home). A retrospective cohort study using registry data for 2010-2016 found that municipal acute units were associated with a statistically significant reduction in both aggregated mortality and hospital readmission rates. The effect was largest in the oldest patient cohort. Due to a policy initiative in 2019, Health Communities between hospitals and municipalities have been established nationwide to improve coordination, planning and development of services. Health Communities play an important role in facilitating specialist services in the community, particularly in mental health. The goal is that outreach hospitals will provide more healthcare in patients’ homes, collaborate better with municipal health and care services, both in person and virtually, and work more closely with other hospitals. Hospital outreach services have received positive evaluations. However, in most regions of Norway, the exchange of information between specialists and primary health care remains a barrier when discharging patients. Conclusions: The experience in Norway illustrates the importance of mechanisms for ensuring the collaboration of hospitals with their surrounding communities.

• Frich, Jan C (2025). Unik bok om ledelse i praksis. Michael. ISSN 1893-9651. 22(3), s. 301–301. doi: 10.5617/michael.12638. Fulltekst i vitenarkiv
• Granberg, A.; Walsem, Marleen Regina Van; Ørstavik, Kristin & Frich, Jan C (2025). 95PFactors that influence physical activity in patients with Charcot-Marie-Tooth disease: a qualitative study. Neuromuscular Disorders. ISSN 0960-8966. 53, s. 106018–106018. doi: 10.1016/j.nmd.2025.106018. Fulltekst i vitenarkiv
• Hem, Erlend & Frich, Jan C (2025). Ibsens lommebok – et innblikk i dikterens resepter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(5), s. 1–16. doi: 10.4045/tidsskr.24.0526. Fulltekst i vitenarkiv
• Frich, Jan C (2025). Helsetjenester og prioriteringer - hvor går veien videre? Michael. ISSN 1893-9651. 22, s. 7–11. doi: 10.5617/michael.12107. Fulltekst i vitenarkiv
• Frich, Jan C & Solberg, Carl Tollef (2025). Bruk av prioriteringskriteriene på gruppe- og individnivå. Michael. ISSN 1893-9651. 22, s. 29–37. doi: 10.5617/michael.12110. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Presisjonsmedisin - i hele helsetjenesten. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Det trengs breddekompetanse i sykehusene. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Helseplattformen og veien videre. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Helseplattformen - historien og veien videre. 24(4), s. 16–17. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Hva er en god veileder? Michael. ISSN 1893-9651. 21(3). doi: 10.5617/michael.11654. Fulltekst i vitenarkiv
• Frich, Jan C; Bahus, Marianne; Barstad, Gina Knutson; Heikkilä, Reino; Mikaelsen, Karin Müller & Olsen, Jan Abel [Vis alle 9 forfattere av denne artikkelen] (2024). Bedre prioritering og tilgang: Dette er ekspertgruppens anbefalinger. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Kvalitet – hvordan vite hva som er gode helsetjenester? 21, s. 52–62. doi: 10.5617/michael.10951. Fulltekst i vitenarkiv Vis sammendrag

  Et velfungerende helsesystem skal legge til rette for gode pasient- og brukererfaringer, fremme befolkningens helse, bærekraftig og god bruk av ressursene og å ivareta personell og kompetanse. I en norsk sammenheng er likhet, likeverdighet og rettferdighet viktige verdier som skal prege tjenestene. Indikatorer for strukturer, prosesser og resultater er en kilde til informasjon om i hvilken grad slike overordnede mål faktisk nås. Den norske kvalitetsstrategien dekker mange overordnede mål, men har ikke tatt opp i seg bærekraft eller ivaretakelse av personell og kompetanse. Strategien er snart 20 år gammel, og det kan være på tide med en revisjon.

• Frich, Jan C (2024). Ujevnt om helseledelse. Michael. ISSN 1893-9651. 21(3). doi: 10.5617/michael.11666. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Hvordan håndtere kostnader til dyre legemidler ved ultrasjeldne tilstander? Fulltekst i vitenarkiv
• Frich, Jan C; Brean, Are & Dietrichs, Espen (2024). Forord. I Frich, Jan C; Brean, Are & Dietrichs, Espen (Red.), Hjernen og mytene. Michael. ISSN 9788292871713. s. 8–8. doi: 10.5617/michael.11728. Fulltekst i vitenarkiv
• Frich, Jan C & Inge, Mjøen Odd (2024). Helseplattformen - krevende vei mot felles pasientjournal. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Helseplattformen - hva nå? Fulltekst i vitenarkiv
• Frich, Jan C (2024). Norsk helsetjeneste i internasjonalt perspektiv. Fulltekst i vitenarkiv
• Rudi, Heidi Merete; Frich, Jan; Husabø, Gunnar & Hovlid, Einar (2024). Healthcare inspectors’ role conceptions: Directing focus towards or away from quality improvement. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Hvordan legge til rette for prioritering på tvers av nivåene i helsevesenet? Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10, s. 237–239. doi: 10.18261/tfo.10.2.16. Fulltekst i vitenarkiv
• Frich, Jan C; Dietrichs, Espen & Brean, Are (2024). Innledning. I Frich, Jan C; Brean, Are & Dietrichs, Espen (Red.), Hjernen og mytene. Michael. ISSN 9788292871713. s. 9–17. doi: 10.5617/michael.11698. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Fremtidsrettet helseledelse - Global Health Leadership Competency Model 2023. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Alternative prisavtaler kan fremme tilgang til behandling. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Trenger vi generalistkompetanse? Fulltekst i vitenarkiv
• Frich, Jan C (2024). Ekspertgruppe for tilgang og prioritering. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Tre nye rapporter om prioritering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(4), s. 262–262. doi: 10.4045/tidsskr.24.0097. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Et varsko for doktorgradsprøven. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Viktig støtte for å bedre Helseplattformen. Fulltekst i vitenarkiv
• Frich, Jan C (2024). Prioritering i spesialisthelsetjenesten – aktuelle problemstillinger. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Debatten: Fødsel mindre verdt enn prostataoperasjon. [TV]. NRK. Fulltekst i vitenarkiv
• Frich, Jan C; Allwood, Dominique; Busari, Jamiu O.; Chan, Ming-Ka; Compagni, Amelia & Gemine, Rachel [Vis alle 20 forfattere av denne artikkelen] (2023). Looking back, leading forward: BMJ Leader 5 years on. BMJ Leader. 7(1), s. 1–2. doi: 10.1136/leader-2023-000754. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Hvordan prioritere bruken av knappe ressurser i helsetjenesten? Fulltekst i vitenarkiv
• Frich, Jan C (2023). Helseledelse - fra skolebenken til virkelighetens jungel. Fulltekst i vitenarkiv
• Frich, Jan C; Flottorp, Signe Agnes & Himmels, Jan Peter William (2023). Viktig med kunnskap om senfølger etter covid-19. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116. Fulltekst i vitenarkiv
• Solbakken, Gro; Bjørnarå, Bård; Kirkhus, Eva; Nguyen, Bac; Hansen, Gunnar & Frich, Jan C [Vis alle 7 forfattere av denne artikkelen] (2023). Magnetic Resonance Imagine (MRI) as a biomarker in neuromuscular diseases. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Derisking generation and use of patient evidence in drug development and decision-making. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Hvordan løse morgendagens utfordringer i helsesektoren? Fulltekst i vitenarkiv
• Frich, Jan C (2023). Kostnadskontroll ved offentlige anbud - hvilke virkemidler rår helsetjenesten over? Fulltekst i vitenarkiv
• Frich, Jan C (2023). Prioritering i helse- og omsorgstjenesten. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Skal samfunnsgevinster telle? Fulltekst i vitenarkiv
• Frich, Jan (2023). Hybridledelse - hva innebærer det? Overlegen. ISSN 1503-2663. Fulltekst i vitenarkiv
• Frich, Jan C & Spehar, Ivan (2023). Gir lederutdanning bedre ledere? Fulltekst i vitenarkiv
• Frich, Jan C (2023). Legemiddelanbud gir tilgang til flere. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Legemiddelanbud og tilgang. Dagens medisin. ISSN 1501-4290. Fulltekst i vitenarkiv
• Chlebus, Magda; Frich, Jan C; Geissler, Jan; Burgos, Juan Garcia; Hivert, Virgine & Spooner, Almath (2023). Advancing use of patient evidence in decision-making. Global Forum. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Er medisin litteratur? Er litteratur medisin? Fulltekst i vitenarkiv
• Frich, Jan C (2023). Teoretisk forankret bok om ledelse. Michael. ISSN 1893-9651. 20(3), s. 512–513. Fulltekst i vitenarkiv
• Frich, Jan C (2023). Litteratur og medisin. Michael. ISSN 1893-9651. 20, s. 133–139. Fulltekst i vitenarkiv
• Hovlid, Einar; Husabø, Gunnar; Teig, Inger Lise; Halvorsen, Kjersti & Frich, Jan C (2022). Response to “Value Driven Regulation and the role of inspections. Commentary to: Hovlid E, Husabø G, Teig IL, Halvorsen K, Frich JC. Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: A realist evaluation. Soc Sci Med 2022 Apr;298:114872”. Social Science and Medicine. ISSN 0277-9536. 308. doi: 10.1016/j.socscimed.2022.115235. Fulltekst i vitenarkiv
• Frich, Jan C (2022). Country overview and updates - Norway. Fulltekst i vitenarkiv
• Frich, Jan C (2022). Nye metoder og prioriteringer – hvordan arbeides det med å forbedre systemet? Fulltekst i vitenarkiv
• Frich, Jan C (2022). Litteratur og medisin. [Internet]. Helsehistorisk forum / Nasjonalbiblioteket. Fulltekst i vitenarkiv
• Bjørnbeth, Bjørn Atle; Myhren, Hilde; Rootwelt, Terje & Frich, Jan C (2022). Nye sykehus i Oslo gir bedre helsetjenester. Fulltekst i vitenarkiv
• Fossberg, Bettina & Frich, Jan C (2022). B. Fossberg og J. Frich svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.22.0278. Fulltekst i vitenarkiv
• Frich, Jan C (2022). Jobbtilfredshet, pasientsikkerhet og endring. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142. doi: 10.4045/tidsskr.21.0854. Fulltekst i vitenarkiv
• Frich, Jan C & Lofthus, Cathrine Marie (2021). Hva pandemien har lært oss om intensivkapasitet og beredskap. Fulltekst i vitenarkiv
• Andries, Aristomo; Walsem, Marleen Regina Van; Ørstavik, Kristin & Frich, Jan C (2021). Funksjonsevne og fysisk aktivitet hos personer med limb-girdle muskeldystrofi og Charcot-Marie-Tooth i Norge. Fulltekst i vitenarkiv
• Bjørnbeth, Bjørn Atle & Frich, Jan C (2021). Et godt sykehustilbud i Oslo. s. 30–32. Fulltekst i vitenarkiv
• Frich, Jan C & Lofthus, Cathrine Marie (2021). Helseforskning som beredskap. Fulltekst i vitenarkiv
• Frich, Jan C (2021). Tillitsbasert ledelse. s. 56–57. Fulltekst i vitenarkiv
• Husabø, Gunnar; Nilsen, Roy Miodini; Flaaten, Hans; Solligård, Erik; Frich, Jan C & Bondevik, Gunnar Tschudi [Vis alle 10 forfattere av denne artikkelen] (2021). Correction: Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PLOS ONE. 16(3). doi: 10.1371/journal.pone.0248879. Fulltekst i vitenarkiv
• Frich, Jan C (2021). Innføringsbøker om helsevesenet i Norge. Michael. ISSN 1893-9651. 18, s. 386–390. Fulltekst i vitenarkiv
• Frich, Jan C (2021). Avsluttende kommentar. Fulltekst i vitenarkiv
• Frich, Jan C; Allwood, Dominique; Berendt, Anthony Robert; Delgado, Pedro; Dunscombe, Rachel & Klaber, Bob [Vis alle 12 forfattere av denne artikkelen] (2021). Seeing and managing the icebergs. BMJ Leader. 5(1), s. 1–2. doi: 10.1136/leader-2020-000378. Fulltekst i vitenarkiv
• Frich, Jan C (2020). Økonomiske effekter av å slå sammen sykehus? Fulltekst i vitenarkiv
• Lofthus, Cathrine Marie & Frich, Jan C (2020). Et halvt år med corona. Fulltekst i vitenarkiv
• Frich, Jan C & Lofthus, Cathrine Marie (2020). Sykehus skal dimensjoneres riktig. Fulltekst i vitenarkiv
• Allwood, Dominique; Berendt, Tony; Delgado, Pedro; Frich, Jan C; Klaber, Bob & Molloy, Aoife [Vis alle 10 forfattere av denne artikkelen] (2020). This is different. BMJ Leader. doi: 10.1136/leader-2020-000250. Fulltekst i vitenarkiv
• Frich, Jan C & Bjørnbeth, Bjørn Atle (2020). Her er planen for nye sykehusbygg i Oslo. Fulltekst i vitenarkiv
• Frich, Jan C (2020). How to make hospitals ready for the long Covid-19 crisis – a Norwegian perspective. Fulltekst i vitenarkiv
• Tjomsland, Ole & Frich, Jan C (2020). Leading wisely in the post-COVID-19 era by Dr. Ole Tjomsland and Dr. Jan Frich. Fulltekst i vitenarkiv
• Frich, Jan C (2020). Ledelse under Korona. Fulltekst i vitenarkiv
• Frich, Jan C (2020). Æsculap 100 år - tradisjon og fornyelse. Æsculap. ISSN 0801-0196. 100(4), s. 29–32. Fulltekst i vitenarkiv
• Lofthus, Cathrine Marie & Frich, Jan C (2020). Mot en mer presis og persontilpasset medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2020). Æsculap - mellom tradisjon og fornyelse. Fulltekst i vitenarkiv
• Frich, Jan C (2020). Hvordan utvikle leger som ledere? Overlegen. ISSN 1503-2663. s. 48–48. Fulltekst i vitenarkiv
• Lyons, Oscar; George, Robynne; Galante, Jao R.; Fordwoh, Thomas; Frich, Jan C & Geerts, Jason M. (2020). Evidence-based medical leadership development: a systematic review. Fulltekst i vitenarkiv
• Skule, Cecilie & Frich, Jan C (2019). Retningslinjen for forebygging av selvmord bør oppdateres. Fulltekst i vitenarkiv
• Vester, Michael & Frich, Jan C (2019). «Compassionate Use» på rett spor. Fulltekst i vitenarkiv
• Frich, Jan C & Bøhler, Geir (2019). Pasienthensynet er førende for ny slagbehandling. Fulltekst i vitenarkiv
• Gaaserød, Hanne & Frich, Jan C (2019). Nye bygg gir bedre og billigere drift i Oslo. Fulltekst i vitenarkiv
• Frich, Jan C & Gaaserød, Hanne (2019). Skal Ullevål utredes enda en gang? Fulltekst i vitenarkiv
• Knutsen, Gro Vik & Frich, Jan C (2019). Bedre kontroll av avtalespesialister. s. 19–19. Fulltekst i vitenarkiv
• Moan, Andreas & Frich, Jan C (2019). Sammen - ikke hver for oss. Utposten. ISSN 0800-5680. s. 36–37. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Hvordan innføre nye metoder? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.18.0289. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Hjerneforskerens slag. I Frich, Jan C; Brean, Are & Dietrichs, Espen (Red.), Hjernen og historien. Michael. ISSN 9788292871843. s. 43–45. Fulltekst i vitenarkiv
• Dietrichs, Espen; Brean, Are & Frich, Jan C (2018). Introduksjon - hjernen og historien. I Frich, Jan C; Brean, Are & Dietrichs, Espen (Red.), Hjernen og historien. Michael. ISSN 9788292871843. s. 7–14. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Ledelse av fremtidens fysioterapitjeneste. Fulltekst i vitenarkiv
• Dalby, Gry Cecilie; Fossmo, Hanne Ludt; Frich, Jan C & Ørstavik, Kristin (2018). TREMUS - gruppebasert trening for muskelsyke. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Samarbeid om gode forløp. Dagens medisin. ISSN 1501-4290. Fulltekst i vitenarkiv
• Frich, Jan C & Lofthus, Cathrine Marie (2018). Bedre behandlingstilbud. Fulltekst i vitenarkiv
• Frich, Jan C (2018). Plenary session III: Keeping Brain Cells Functioning - Can we slow Disease Progression? Fulltekst i vitenarkiv
• Andries, Aristomo Ibnu Chalid; Walsem, Marleen Regina Van & Frich, Jan C (2018). Physical activity in people with Limb-Girdle Muscular Dystrophy and Charcot-Marie-Tooth disease in Norway. Fulltekst i vitenarkiv
• Andries, Aristomo; Walsem, Marleen Regina Van & Frich, Jan C (2018). Physical activity in people with Limb-Girdle Muscular Dystrophy and Charcot-Marie-Tooth disease in Norway. Fulltekst i vitenarkiv
• Frich, Jan C (2018). En kronisk sykdom med ulike årsaker. [Journal]. Allers. Fulltekst i vitenarkiv
• Frich, Jan C & Spehar, Ivan (2018). Ledelsesutvikling for leger. 138(15), s. 1418–1419. doi: 10.4045/tidsskr.18.0645. Fulltekst i vitenarkiv
• Bretthauer, Michael; Vandvik, Per Olav; Skjeldestad, Finn Egil; Frich, Jan C; Lange, Thomas de & Løberg, Magnus (2017). Ny spesialistutdanning for leger – fra sveitserost til kraftkar? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(17), s. 1270–1271. doi: 10.4045/tidsskr.17.0637. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Towards a national exam in medical education – experiences with the pilot in 2017. Fulltekst i vitenarkiv
• Bjørndal, Arild; Borchgrevink, Christian Fredrik; Frich, Jan C; Gulbrandsen, Pål; Lie, Anne Helene Kveim & Malterud, Kirsti [Vis alle 9 forfattere av denne artikkelen] (2017). Per Fugelli. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137. doi: 10.4045/tidsskr.17.0800. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Smakebiter på forskning på ledelse i offentlig sektor. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Sjelden sykdom: - Det var forferdelig å lese om sykdommen, jeg trodde at jeg ville dø i løpet av kort tid. [Journal]. KK. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Oppfordrer sykehusleger til å studere ledelse. [Journal]. Tidsskrift for Den norske legeforening. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Generelle trender som påvirker tilbudet og etterspørselen etter helsepersonell. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Huntingtons sykdom. I Huseby, Inger; Eldøen, Guttorm & Gjerstad, Leif (Red.), Statusrapport hjernehelse. Helsedirektoratet. s. 29–30. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Hva er optimal størrelse på et sykehus? Fulltekst i vitenarkiv
• Dalby, Gry Cecilie; Fossmo, Hanne Ludt; Frich, Jan C & Ørstavik, Kristin (2017). Gruppebasert trening for muskelsyke. MUSKELnytt. s. 6–6. Fulltekst i vitenarkiv
• Graver, Hans Petter & Frich, Jan C (2017). Kultur for kvalitet. Uniforum. ISSN 1891-5825. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Ledelse av legetjenestene i kommunene. I Kristoffersen, Jan Emil; Lerum, Sverre Vigeland; Maurud, Hedda; Carlsen, Tor; Heilemann, Aadel & Mjelva, Sara Underland (Red.), Pasientens primærhelsetjeneste må ledes: om ledelse av det medisinske tilbudet i kommunene. Den norske legeforening. ISSN 9788280702036. s. 42–58. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Ny behandling av Huntingtons sykdom kan være på vei. [Internet]. Forskning.no. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Vinner av Kunnskapsdepartementets utdanningskvalitetspris: Nasjonal delprøve i medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Status for nasjonal delprøve i medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2017). - Altfor mange pasienter i kø. [Journal]. Dagens medisin. Fulltekst i vitenarkiv
• Walsem, Marleen Regina van; Howe, Emilie & Frich, Jan C (2017). Assistive technology for cognition in HD. HD Insights. 16, s. 12–12. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Hver lege kan tape 16.000 kroner. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Tror legene taper på alle punkt. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2017). - Legene har det ikke verre enn andre. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Nå får medisinstudentene for første gang en nasjonal prøve. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Spehar, Ivan; Klev, Nils Kristian; Rokstad, Kirsten Skinlo; Rosvold, Elin Olaug & Frich, Jan C (2017). Ledelseskurs for leger i primærhelsetjenesten. Utposten. ISSN 0800-5680. 46(6), s. 42–43. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Den om tilbakemelding. [Internet]. NOKUT-podden: en podcast om høyere utdanning. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Læremidler og læring i medisinen. Michael. ISSN 1893-9651. 14(2), s. 83–85. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Prioriterer pasienter, ikke fagmiljøer. [Internet]. NRK Troms. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Økonomisk styring – et ledelsesperspektiv. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Professor Jan Frich om legers angst for å gjøre feil. [Radio]. NRK. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Fastleger og ledelse: Vi har ikke vært flinke nok til å engasjere oss. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Frich, Jan C; Andersen, Stine; Baerheim, Anders; Ellingsen, Maren; Johanson, Gard Aasmund Skulstad & Lockert, Oda [Vis alle 8 forfattere av denne artikkelen] (2017). En felles prøve for alle legestudenter i Norge. 137(17), s. 1277–1278. doi: 10.4045/tidsskr.17.0536. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Nekter å dokumentere effekt på medisin – tjener penger på smutthull. [Internet]. NRK. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Resept for en bedre helsetjeneste? 137(16), s. 1221–1222. doi: 10.4045/tidsskr.17.0495. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Ser du sebraen? UNIK - et magasin om å leve med en sjelden diagnose. s. 59–59. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Helsepersonell i morgendagens helsetjeneste – trender og behov. Fulltekst i vitenarkiv
• Martinussen, Pål Erling; Magnussen, Jon; Frich, Jan C & Vrangbæk, Karsten (2017). Hvordan bør sykehusene styres? s. 20–21. Fulltekst i vitenarkiv
• Frich, Jan C (2017). Hvorfor prioritere forskning på sjeldenområdet? Fulltekst i vitenarkiv
• Frich, Jan C (2017). - Vil gjøre journalen til et dårligere arbeidsverktøy. [Journal]. Journalen. Fulltekst i vitenarkiv
• Frich, Jan C; Bahus, Marianne; Barstad, Gina Knutson; Heikkilä, Reino; Olsen, Jan Abel & Mikaelsen, Karin Müller [Vis alle 9 forfattere av denne artikkelen] (2024). Rapport fra ekspertgruppen om tilgang og prioritering: Nedsatt av Helse- og omsorgsdepartementet. Helse- og omsorgsdepartementet . Fulltekst i vitenarkiv Vis sammendrag

  Stortinget har sluttet seg til de tre prioriteringskriteriene nytte, ressursbruk og alvorlighet. Norge har to sentrale systemer for prioritering av offentlig tilgang til nye metoder i helse- og omsorgstjenesten: systemet for innføring av nye metoder i spesialisthelsetjenesten (Nye metoder) og ordningen for forhåndsgodkjent refusjon og individuell stønad i blåreseptordningen (blåreseptordningen). De to systemene bidrar til at metodene som innføres, oppfyller prioriteringskriteriene og kravene til åpenhet, likebehandling og ressursbesparelser. Gjennom ti møter, flere eksterne rapporter og råd og innspill fra en rekke fag- og interesseorganisasjoner har Ekspertgruppen om tilgang og prioritering (heretter omtalt som «Ekspertgruppen») utredet dagens situasjon for Nye metoder og blåreseptordningen med hensyn til forholdet mellom prioriteringsbeslutninger på gruppe- og individnivå. Fremveksten av persontilpasset medisin og nye genterapier, samt øvrige avanserte og dyre nye metoder, utfordrer dette forholdet. Ekspertgruppen har vært opptatt av at flest mulig i befolkningen skal få rask og rettferdig tilgang til effektive metoder, innenfor gjeldende økonomiske rammer. Vurderingene som gjøres i de to prioriteringssystemene (Nye metoder og blåreseptordningen), skal i tillegg være forståelige og velbegrunnede, særlig ved beslutning om å ikke innføre en ny metode. I tråd med verdigrunnlaget i den norske offentlige helse- og omsorgstjenesten har prinsippet om likebehandling stått sterkt i utredningsarbeidet: Like tilfeller skal behandles likt. Ekspertgruppen anbefaler følgende ti tiltak som sammen skal fremme rettferdig tilgang til effektive metoder i den offentlige helse- og omsorgstjenesten: 1. forbedre informasjon om prioriteringssystemene og styrke kunnskap om prioritering hos klinikere og andre beslutningstakere 2. målrette arbeidet med metodevurderinger og undergruppeanalyser 3. øke pasienters mulighet for deltakelse i kliniske studier 4. innføre en ordning for vurdering av individuell tilgang etter nei-beslutning i Nye metoder 5. innføre en ordning for vurdering av individuell tilgang og gruppeunntak ved revurdering av metoder i Nye metoder 6. ikke åpne for at privatfinansiert behandling kan utgjøre et selvstendig grunnlag for tilgang til behandling i den offentlige helse- og omsorgstjenesten 7. ikke åpne for unntak før metodevurdering er gjennomført for blåreseptordningen 8. øke bruken av prisavtaler for å håndtere usikkerhet om effekt og risiko, særlig ved sjeldne diagnoser 9. legge til rette for «compassionate use» av legemidler for pasienter med forventet behandlingsvarighet under seks måneder 10. etablere nasjonale systemer for registrering og evaluering av ordninger for unntak og individuell tilgang

• Solbakken, Gro; Ørstavik, Kristin; Frich, Jan C & Dietrichs, Espen (2021). Trunk Muscle Impairment and Pain in Myotonic Dystrophy type 1: Association to CTG size and Function. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Myotonic Dystrophy 1 (DM1) is a progressive, hereditary neuromuscular disorder with multi-organ involvement. The genetic cause is an unstable CTG trinucleotide expansion in the DMPK gene at chromosome 19. Muscle involvement is expected to be distal in the extremities, the face and neck. Pain has not been described as part of the symptom complex. We investigated trunk muscle impairments, myopathy and pain in adult forms of DM1, and explored associations to function, CTG size and disease duration. In a cross-sectional design, 50 subjects with DM1 and 20 healthy age and gender-matched controls were included. Motor and psychological function, muscles and peripheral nerves were investigated. Clinical testing documented early and severe impairment in trunk muscles. An MRI study confirmed high degree of muscle fat infiltration and atrophy of trunk muscles. The clinical and radiological findings were significantly correlated to CTG size, disease duration, mobility, balance and respiration. We found high frequency of chronic pain (84%), most frequent locations were the lower back, neck and palmar side of the hands. Significant higher pain intensity and more pain locations was documented in women compared to men. In a sub study neuropathic pain was the probable mechanism in 15 %. Overall, pain was related to CTG size, quality of life, fatigue and respiration. In adult subjects with DM1, clinical impairment of trunk muscle function and objective findings of myopathy were clearly documented in our studies. These findings were related to motor function and CTG size. Pain was frequently reported, and gender differences significant. These findings suggest that follow up programs should include regularly assessment of trunk muscle function and pain in DM1. Whether trunk muscle impairment can be prevented or limited by exercise could be an important topic for a clinical intervention study. Pain studies accounting for gender differences should be conducted.

• Lippe, Charlotte von der; Solbrække, Kari Nyheim & Frich, Jan C (2018). Not just a carrier – A qualitative study of psychosocial aspects of women’s experiences of living with an X-linked disorder. Universitetet i Oslo. Fulltekst i vitenarkiv
• Lerum, Sverre Vigeland; Frich, Jan C & Solbrække, Kari Nyheim (2017). Managing and caring for individuals with amyotrophic lateral sclerosis/motor neurone disease in Norway: a qualitative study. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Amyotrofisk lateral sklerose (ALS) er en sykdom som fører til gradvis muskelsvinn. Forventet levetid varierer mellom 2 til 5 år, men enkelte kan leve betydelig lengre. Det er ingen kjent kur. Avhandlingen følger ALS gjennom norsk helsevesen – i hjemmet, kommunehelsetjenesten og på sykehus. Den er basert på 53 kvalitative intervjuer med tre grupper: personer med ALS og pårørende i hjemmet, helsepersonell i kommunehelsetjenesten og på sykehus. Omsorgsarbeidet i ALS er svært omfattende, og krever samarbeid mellom gruppene for at det hele ikke skal bryte sammen. Avhandlingen foreslår et nytt begrep, «ustabil terminalitet», som handler om en grunnleggende usikkerhet i ALS. Selv om en person med ALS blir stadig svakere og ikke blir frisk, er det i noen tilfeller mulig å forlenge forløpet nesten til ubestemt tid om en har arbeidskraft og teknologi tilgjengelig. De som er intervjuet kan veksle mellom å forstå ALS som et terminalt forløp hvor man forbereder seg på dø, eller et kronisk forløp hvor man er svært svak men forbereder seg på en hverdag. Å veksle mellom disse to tilnærmingene kan de gjøre gjennom hele forløpet, også når de ser tilbake i ettertid. Slik ustabil terminalitet utfordrer hva man skal gjøre i gjenopplivingssituasjoner, hva slags helsetjenester man skal ta i bruk (for eksempel hospice) og det kan bli konflikt mellom personer om noen i forløpet arbeider mot å forberede seg på døden, mens andre ikke gjør det. I avhandlingen presenteres forskjellige typer omsorgsarbeid i ALS fra pårørendeperspektiv. For eksempel hvordan pårørende jobber for å finne informasjon om sykdommen, håndtere andre forpliktelser, opprettholde normalitet eller tar i bruk helsepersonell hjemme. Pårørende må gjennom ALS-forløpet balansere egen kapasitet, behov og forventninger til seg selv og fra andre. Deltakerne i studien som arbeider i kommunehelsetjenesten forteller om store utfordringer. Personer med ALS bor stort sett hjemme hos seg selv. Oppgavene kommunehelsetjenesten skal utføre der er kompliserte og alvorlige – liv og død står på spill. Deltakerne fra kommunehelsetjenesten forteller om utfordringer med å sikre godt arbeidsmiljø til ansatte og å holde på personell over tid. I enkelte kommuner forteller deltakerne om store rekrutteringsproblemer, som i noen tilfeller baserer seg på rykter i området.

• Walsem, Marleen Regina Van; Andelic, Nada & Frich, Jan C (2017). Unmet healthcare needs, healthrelated quality of life and assistive technology for cognition in Huntington’s disease. A population-based cross-sectional study. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Patients with Huntington’s disease (HD) need tailored multidisciplinary healthcare to maintain and optimize function and health-related quality of life (HRQoL). The aims of this thesis were to describe the levels and prevalence of unmet needs for healthcare and social support services in patients with HD, and to study factors associated with unmet healthcare needs, particularly the association with HRQoL. The thesis also investigates the use of assistive technology for cognition (ATC) and associations with HRQoL as a case of a supportive unmet healthcare need. Substantial unmet needs for healthcare and social support services for patients with HD were revealed. High levels of unmet needs were found at all five disease stages (I-V), but being in the middle phase of HD (disease stage III) increased the odds by 3.5 times. Higher levels of unmet needs were associated with lower HRQoL. ATC was used infrequently. An association between ATC use and HRQoL was not found, but ATC was significantly associated with functional ability. The thesis addresses an important gap in the scientific literature regarding healthcare service delivery to patients with Huntington’s disease.

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